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EKG Flashcards

1
Q

Where are your lead placements?

A 
V1 - 4th ics r sternal
V2 - 4th ics l sternal
V3 - between V2 and V4
V4 - 5th ics midclavicular
V5 - 5th ics anterior axillary
V6 - 5th ics midaxillary
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2
Q

What does the QT interval represent

A

Time between ventricular depolarization and repolarization

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3
Q

Time for QT interval?

A

.36 - .44 sec

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4
Q

PR interval normal time?

A

0.12 - 0.2 secs

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5
Q

QRS complex time?

A

(Just smaller than P wave)

< 0.12 sec

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6
Q

What does ST depression represent?

A

Myocardial ischemia

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7
Q

What does ST elevation represent?

A

Full Thickness Myocardial Infarction

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8
Q

What does a T wave inversion that looks like a U (other than in V1) represent?

A

Ischemia (just remember if its below the line it’s ischemia - same as ST segment)

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9
Q

What leads represent the lateral aspect of the heart?

A

I, aVL, V5-V6

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10
Q

What leads represent the inferior aspect of the heart?

A

II
III
aVF

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11
Q

What leads represent the anterior area of the heart?

A

V3

V4

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12
Q

What is indicative of a left bundle branch block?

A

Wide QRS ( taking longer for signal to get to left ventricles for depolarization )

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13
Q

What is the gold standard for diagnosing cardiac arrythmias?

A

ECG

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14
Q

What are your treatment options for cardiac arrythmias?

A

ABCs, IV, O2, Monitor (ALWAYS)

  • antiarrythmics
  • cardioversion
  • transcutaneous pacing
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15
Q

What are the complications of arrythmias?

A

Decreased cardiac perfusion

  • AMI
  • Syncope
  • Cardiac Arrest
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16
Q

What is the normal intrinsic rate for a Sinus rhythm?

A

60 - 100 bpm

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17
Q

Textbook Sinus Brady symptoms?

A

Normal sinus rhythm but < 60bpm

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18
Q

Symptoms of severe bradycardia?

A

< 45 bpm

  • weakness
  • syncope
  • N/V
  • lightheaded
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19
Q

1st step to treating bradycardia?

A

Identify if stable or unstable

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20
Q

Signs of unstable arrythmias?

A
  • Change in mental status
  • Ischemic chest discomfort
  • Hypotension
  • Signs of shock
  • Acute heart failure
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21
Q

How do you treat unstable brady?

A

Atropine 0.5mg IV, repeat q3-5 min max 3mg

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22
Q

Why would atropine not work for brady?

A

If the SA node is not actually being inhibited by vagal tone, then atropine will not have an effect. Atropine only inhibits vagal input

  • Heart transplant removes vagus nerve innervation with the heart
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23
Q

Is Mydriasis a side effect of atropine?

A

Yup

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24
Q

What do you use if atropine is ineffective?

A 
Transcutaneous pacing
OR
Dopamine IV 2-10mcg/kg/min
OR
Epi IV 2-10mcg/min (1:10,000)
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25
Issues with severe brady?
Poor cardiac output leading to issues that would result from that
26
Tachycardia is what hr?
> 100
27
Are there any abnormalities on the ECG for Sinus Tachy?
Nope just greater than 100 bpm
28
First treatment for Sinus Tachy?
Basics: ABCs, IV, O2, Monitor Treat underlying cause Determine stable vs unstable
29
What classifies an arrythmia as unstable?
MISHA is looking Ischemic ``` M - mental status I - ischemic chest discomfort S - shock H - hypotension A - acute heart failure ```
30
PSVT means?
Paroxysmal SVT
31
What does paroxysmal mean
comes and goes
32
So supraventricular means?
From above the ventricles nerd
33
What symptoms would you expect for a SVT?
* Palpitations * SOB * Chest pain * SVT doesn't typically last
34
Whats the most common mechanism of PSVT?
Atreioventricular Nodal Reentry Tachy
35
HR for PSVT?
150 - 240
36
Unstable arrythmia symptoms?
MISHA is ischemic ``` M - mental status changes I - ischemic chest discomfort S - shock H - hypotension A - acute heart failure ```
37
What are your ecg findings for PSVT?
* HR 150-220 * P wave somewhere in the QRS * Narrow QRS * Regular R-R interval (so it's regular just super fast and a tiny qrs)
38
First treatment for any arrythmia?
ABCs, Monitor, IV, O2 Determine Stable vs Unstable
40
What can you do as a mechanical measure to reduce tachycardia?
Stimulate vagal nerve: * Valsalva * hold breathe * face in cold water * carotid sinus pressure 10-20 sec
41
First line Drugs for PSVT unstable
3 Strikes and you're out 1. Adenosine 6mg IV with saline flush 2. Repeat with 12mg 3. Third time is it at 12mg but that's it
42
What does it mean when we say hemodynamically stable?
Blood pressure and HR are controlled, so when you see BP "crashing" this person is no longer hemodynamically stable
43
Treatment for no longer hemodynamically stable with PSVT
Synchronized cardioversion 50-100J
44
What is Wolf Parkinson White Syndrome?
Basically there is a bypass of the AV node and can cause reentry arrhythmias - leading to PSVT
45
Second line drugs for PSVT?
Metoprolol - 5mg IV / 50mg PO (AMAL) Diltiazem - .25mg/kg IV
46
Symptoms of WPW?
Same as PSVT * SOB * Chest pain * Palpitations
47
Basic first treatment of all arrhythmias?
ABCs, Monitor, IV, O2 Determine if stable vs unstable Treat underlying causes
48
Treatment for Unstable WPW
Immediate Cardioversion 50-150J Adenosine 6mg, then 12, then 12 Metoprolol 5mg IV / 50mg PO
49
What J do we always cardiovert at for arrythmias?
50 - 150 J
50
Definitive treatment for WPW?
Cardiologist for catheter ablation
51
What is the most common chronic arrythmia?
A FIB
52
What is A FIB
Electrical storm in the atria just firing off causing it to fibrillate and not contract in an organized manner
53
ECG findings for A-Fib
Just a wavy line (wavy baseline) Irregularly Irregular R-R interval
54
What diseases may increase occurence of A-Fib?
``` HTN Pericarditis Holiday heart (alcohol) Excess caffeine Electrolyte abnormalities (potassium and magnesium) ```
55
Is A-Fib life threatening?
Only when ventricular rate starts creating unstable conditions
56
What does A-fib pre-dispose patients to?
Thromboembolic events
57
What are increased risk factors for A-Fib and stroke?
* HTN * Dyslipidemia * CHF * History of embolisms
58
Any hallmarks for A-Fib?
Wavy baseline ECG | Dyspnea on exertion
59
Why do you not cardivert for patients with A-Fib longer than 48 hours?
Pooling of blood in ventricles, so without anticoagulation therapy, pt may throw a clot
60
What do you do for someone that has had A FIB for longer than 48h?
Anticoagulants for 3 weeks prior to cardioversion
61
What is the goal of treatment for A FIB?
focus on ventricular rate control
62
Treatment meds for arrythmia portion of AFIB?
Metoprolol 5mg IV / 50mg PO Diltiazem .25mg IV
63
Treatment meds for anticoagulation of A FIB?
Enoxaoarin 1mg/kg SC q 12h | weakens clot formation
64
What is Atrial Flutter usually associated with?
Pulmonary disease
65
What is the atrial rate in A FIb?
400 bpm
66
What is the atrial rate in A Flutter?
250 - 350 bpm
67
ECG presentation of Atrial Flutter?
A-Flutter has lots of P waves, but they are not always conducting a QRS - 2:1, 3:1, 4:1 Saw tooth flutter waves between QRS complexes
68
Goal of treatment for A flutter?
Convert AF to sinus rhythm | Control ventricular rate metoprolol and diltiazem
69
Is A flutter ventricular rate easier or harder to control than A FIB?
It's harder to control with Metoprolol or Diltiazem than A FIB
70
Treatment for unstable A-Flutter?
Immediate cardioversion 100-200J
71
What are the 3 types of V-Tach
* Non-sustained - 3 or more premature beats lasting < 30 seconds and terminating * sustained * Pulseless
72
What are the most common causes of V-Tach?
* AMI * ischemic heart disease * electrolyte abnormalities
73
EKG presentation of V-Tach?
Wide QRS (longer than .12) No P waves HR > 160 - 240 Moderate regular R-R interval
74
Can you be asyptomatic with V-Tach?
Yes
75
Basic treatment for VTach?
ABCs, Monitor, IV, O2
76
Treatment for pulseless Vtach?
ACLS protocol
77
Treatment for stable VTACH?
MEDAVICE and possibly antiarryhtmia drugs
78
Treatment for unstable VTACH?
immediately perform synchronized cardioversion 100 - 200J
79
Treatment meds for VTACH
Lidocaine .5mg/kg IV q5-10 min Amiodarone 150mg IV over 10 min Magnesium 2g IV (if low magnesium levels due to diuretics, alcoholism, diarrhea, or acute pancreatitis)
80
Though WPW sydnrome can be associated with PSVT, what are the differences in the ECG?
* Wide, slurred QRS with a delta wave | * Short PR interval (not hidden and < .12)

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